TORONTO - A photo of a woman's chest tattooed to cover mastectomy scars, which went viral after she posted it on Facebook, has highlighted a growing trend among cancer survivors.

More and more are getting inked, not just to beautify surgical sites, but as a badge of honour — a visible reminder that they beat the disease.

Casandra Graham had a single mastectomy after being diagnosed and treated for breast cancer in 2009. And although she opted for reconstruction — moving tissue from her abdomen to create a new left breast — she wasn't keen on having a surgically created nipple.

"I had looked on the Internet at probably thousands of photos of nipple reconstructions and as good as the job may be, it'll never be exactly the same as your other one because it's just not natural anymore," Graham, 38, said from her home in London, Ont. "And I didn't like how it looked.

"So I said, you know what, I'm just not going to do it at all. And since I happened to know a couple of tattoo artists — my husband owns a shop — I'll just get it tattooed."

Graham put together a design that combined several images she found online, including small hearts, a pink ribbon that symbolizes breast cancer, and some tiny stars.

But the central motif of her pink and black tattoo is a treble clef.

"I can't sing, I can't carry a tune in a bucket ... I'm not a musician of any sort, but I really like music and it was one of the strong things when I was alone that kind of kept my spirits up."

Graham, the mother of two teenagers, has 16 other tattoos, including a pink ribbon on the back of her neck to commemorate her godmother who died of breast cancer.

She described the one adorning her reconstructed left breast as "a very girly tattoo," soft and flowy.

"You know how people get pink ribbon tattoos or buttons or clips or whatever and they say 'survivor' or they say 'courage' or 'hope.' I wanted something kind of like 'survivor,' but I didn't want it to be like, yeah, I'm just surviving my life.

"Survivor seems too cliche for me. So I had in pink writing around the side of the tattoo, I had them write: 'I am living,' because I feel like I'm not just getting by, surviving one day to the next. I'm actually living my life now.

"I don't see things the way I did before my diagnosis. I see them very differently."

While Peter Laneas, 36, didn't choose to ink the word "survivor" as part of the tattoo on his upper right arm, the design declares that in his battle with cancer, he has come out the winner.

The Toronto actor was diagnosed with testicular cancer twice — the first time in late 2002 at age 26, and in his other testicle in early 2006 when he was 29.

On his 35th birthday, Laneas was in a tattoo shop with his brother and decided on the spur of the moment to get another tat — he already had four — to mark more than five years of being cancer-free.

"It was sort of impulsive and the tattoo artist, she was amazing," he said. "I was thinking like a scorecard or something like that. I didn't know what I wanted to do exactly and my brother helped design it."

The tattoo, which is written in Greek to reflect his half-Greek heritage, says "cancer zero and me two, in Roman numerals," explained Laneas.

The scorecard is inked in red, yellow, blue and white, the colours in the flags of countries that reflect his ethnicity — Greek, Slavic-Macedonian and Ukrainian.

Underneath is written "IV Adam," or For Adam, a memorial to Adam DeSousa of Kitchener, Ont., who died in 2003 of testicular cancer at age 18, prompting his mother Cheryl Perry to found the Canadian Testicular Cancer Association.

Laneas is one of many cancer survivors who has posted his story and photo on the Facebook page, Why We Ink, a project begun by Julie Fitzsimmons with the aim of putting together a book to celebrate those who have beaten cancer and to remember those who have died of the disease. Proceeds from the yet-unpublished book will go to cancer support groups.

Fitzsimmons, a Toronto casting director, lost her brother Owen to colon cancer in 2010. The tattoo on her right shoulder of a dove is a memorial to her older sibling.

Laneas, who met Fitzsimmons through his acting work, decided to be photographed as a boxer for the book, though he has never been in the ring.

"I've chosen to own the representation of the cancer fighter," he said. "I'm not afraid to be that kick-ass guy.

"When I look at the tattoo and I think about it, it's a testimony," said Laneas, who volunteers with cancer organizations and provides peer support to young people with the disease.

"It is a testimony not just to honour the friends that I've made in my life, but it's also to honour myself.

"It's a badge of honour."

Erika Zammitti, who was diagnosed with leukemia at 14, has also posted her story and tattoo photos on Why We Ink.

Now 21 and a student at Centennial College in Toronto studying early childhood education, Zammitti got her first tat at 17, a depiction on her right wrist of a small orange ribbon representing leukemia and the word "Believe."

At 19, she got inked again — this time with the words "dream love cure" on the side of her left foot. A year later, she added a third on the top of her left shoulder. "In Roman numerals, it says '08/30/2006' and right under, it says '12/16/2008,' which are the diagnosis and remission dates of my cancer," she wrote on the Why We Ink page.

"I think my tattoos are a way to show how proud I am because I've survived and it's just a part of me," she said in an interview. "And I think it shows people that it's something I won't ever forget."

Zammitti has numerous scars left by her treatment: from the ports where the chemo was administered; from the surgery to remove her gallbladder destroyed by those drugs; and from the uncounted needle sticks needed for the seemingly unending blood tests.

The tattoos are "just a reminder of how strong I am," she said. "I think tattoos are awesome and I think they're even more awesome when they have meaning behind them."

For Sandi Quig, getting a post-cancer tattoo was both practical and inspirational.

Diagnosed in 2004 with breast cancer that had spread into her chest wall and lymph nodes, the registered nurse chose to have not only her malignant left breast removed, but also her right one.

"I'm a Libra. I tell people that's why I wanted both off, because I'm a Libra and I like balance," quipped Quig of Osoyoos, B.C.

In truth, she was worried that the cancer could recur in her right breast. "Also because, seriously, I couldn't see the point in having one boob" and she didn't want reconstruction.

"Number 1, I felt like I'd been just given a death sentence. I just wanted it out, gone. And also I wasn't concerned about my physical appearance. I was concerned about my life."

Following months of chemo and radiation, Quig went to see Simon Drolet, owner of Art Therapy Corp. in Osoyoos, who had given her a tattoo before she began treatment.

"I had Simon put a tiny little angel right at the top of my spine, the base of my neck, a little angel holding up my children's initials. So whatever happened to me, I would have my children with me," she said.

This time, Quig wanted a design to cover her double-mastectomy site. So last spring, Drolet came up with a grey and black design of swirling stems and leaves that flow out from a chakra lotus in the centre of her chest.

"The reason I made that final decision to have it was when I saw myself naked, when I thought of myself naked, I didn't want to see or think of something missing," said Quig, 54. "I wanted to think of something beautiful or see something beautiful.

"I didn't want like a Betty Boop. I wanted something spiritual."

Drolet, a Quebec tattoo artist who has lived in Osoyoos for the last decade, said Quig's tattoo is the only one he has done over mastectomy scars, though he has created small memorial tats of pink ribbons and other symbols for clients who have lost loved ones to cancer.

"She cried when she saw it at the end, she was so happy," he said of Quig. "She came back and asked for more because she really liked it."

Quig recently returned to have the design enlarged, so it now goes up and along her shoulders.

"It's still fairly new, so I look at it and think, 'Wow, I love that. It's beautiful,' she said. In fact, she's so taken with the tattoo and what it means that she even goes topless on private beaches and at friend's homes.

"The little tattoo at the base of my neck was to see me through it," she says of her diagnosis and treatment. "And now here's this great big tattoo. It's done and I am better for it. I'm bigger than it. I'm a better person than I was before.